Inspecting for better lives Key inspection report
Care homes for adults (18-65 years)
Name: Address: Westonia Court London Road Bedford Bedfordshire MK42 0QE The quality rating for this care home is:
two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Dragan Cvejic
Date: 1 6 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home
Name of care home: Address: Westonia Court London Road Bedford Bedfordshire MK42 0QE 01234350641 01234350641 carol.davison@macintyrecharity.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : MacIntyre Care care home 8 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 8 Westonia Court provided accommodation to eight adults with a learning disability. The home has been formed from part of an existing sheltered housing scheme for older adults. It was, however, completely self-contained and consisted of a main house with two storeys, which had been the wardens accommodation. This was attached to what had originally been independent bed-sitting rooms on two storeys. The main house had a communal lounge/diner, an activity room, quiet room, and office. There was a corridor to the service users rooms, on which was sited the laundry. The home had an enclosed garden and patio facility. The home was situated on a main road about one mile from Bedford town centre, with all the facilities provided by a large town, including a bus station and railway station. The fees are given on request and the last inspection report is also available through the home. Care Homes for Adults (18-65 years) Page 4 of 27 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home
peterchart Poor Adequate Good Excellent How we did our inspection: The site visit, which gave the most information for this report was carried out unannounced in the afternoon and evening hours, when people that use the services returned to the home after their regular day activities. Three service users were case tracked. This means that we explored how life for them looked like in the home. We spoke to them, checked their files, their bedrooms, their medication, their money records and spoke to staff about them. We attended a staff meeting and spoke to staff. Althought the main staff files were kept in the organisation head office, the copies of main documents and current training records, supervision notes and other documents imprortant in everyday work were also kept here and were checked for three staff members. The manager helped the inspection by providing evidence for what we asked for. Care Homes for Adults (18-65 years)
Page 5 of 27 As we concentrated on outcomes, on the results of care processes for people living in this home, we relied on their comments, on observation of their contacts with staff and on what they showed and told us. We invited one of the users of the service to the final feedback, when we reported summary of our findings and asked him to comment on any aspect or fact that we wanted to publish in this report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 7 of 27 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our findings
Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users were properly assessed and could choose the home, resulting in service users feeling at home and being cared for according to their assessed needs. Evidence: The home produced a good information pack, according to what two users of the service stated. The manager stated that she would review and update their statement of purpose again, once the plans for re-development of communal areas arrive to the home, regardless of the time scale for yearly reviews. This would ensure that the statement of purpose is always up to date. Three checked files all contained evidence of well conducted initial assessments prior to offering permanent places to users of the service. Risk assessments were also drawn up at this point, ensuring protection of users from the first day in the home. There were dated reviews of these assessments in all checked files, showing that the home carried out regular reviews. One of the files demostrated that the initial assessment addressed abnormal nail growth for a user. The home arranged for him to regularly see a chiropodist, despite
Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: the managers completed training for trainers for nails cutting, as this condition was considered more serious and required specialist intervention. All users of the service stated that their needs were met. Their records confirmed in various sections how the needs were met. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users were treated as individuals and their individual abilities were promoted and they were encouraged to take risks and explore new areas, ideas and events as they wanted. Evidence: Three care plans were checked in scrutinised files, as a part of case tracking method of inspection. Plans were detailed and described the actions expected from staff to help and support users of the service. The new format of care plans, recently introduced, were shorter, but still contained sufficient details, while allowing staff to learn about each individual user in less time. Any small restrictions were adderssed in risk assessments, such as keeping mouthwash for a user in the office and supervising him when he independently brushed his teeth. A user agreed to move to the ground floor flat, as this better suited her changed needs and allowed staff easier access to her when she needed staff support. Special
Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: equipment, a vibrating pillow and flash beakon were obtained to help meet the needs of a user and to protect her better. A user with difficulties writing signed the sheet in front of his file, so that all staff knew how he signed his documents. One-to-one sessions with staff created an atmosphere of trust among users of the service. Two users were relying on this, special relationship to voice their wishes, preferences and raise any issues they might have in an open and trustworthy relationship. One of the files checked indicated how the family of a user was involved and expressed full satisfaction with care for their relative. Users were encouraged to make their own decisions. A user decided to buy a new TV and the home arranged for Mental Capacity assessment to be carried out, to ensure her protection. Another assessment was carried out for another user prior to the planned holiday. Risks were well assessed at the admission and than were regularly updated. One of the checked risk assessment was presented in DO and DO NOT form for staff stating among others: do not treat him as a child. Although the home kept some of the users money, risk assessments showed why this was the case, as the risk of wasting money due to limits in capacity was high. The home kept accurate records and in all three checked cases, the amount in money boxes was accurate and matched the signed records. The manager and another staff audited all the money once a month, improving the financial protection of service users. The home encouraged new communication methods. Each day there was a new Makaton sign on a board, allowing users to slowly but consistently learn how to communicate better. Users were encouraged to take part in the running of the home. One of the users was present at the feedback at the end of the site visit and he confirmed that the evidence collected was factually accurate. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users were able to control their lives and were supported to exercise choice, independence, their rights, and to explore reasonable risks, above the minimum standards. Evidence: She so much improved her communication skills, so she communicates with us, stated a family of a users, showing their satisfaction with work on personal development the home achieved with the user. A user that showed us his room and spoke to us in length of his experiences of living in the home, was using a kettle and making drinks for himself independently. All service users were attending a day centre four days a week. A user was doing a paid weekend job with therapeutic payments. One of the users was playing drums, another was a keyboard player and the home
Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: arranged a monthly musical session that the majority of users took part in. Learning Makaton, a sign language, helped users develop communication skills. The homes residents were occassionally invited to the local, nearby school to the events organised there. Users were regularly doing their shopping in Bedford city centre. The homes minibus provided opportunities for regular outings and other planned activities. The list of activities and records of participating users showed that all users were involved in leisure activities and the variety suited users likes and preferences. Service users kept the keys to their flats. One user, when asked did not want us in her room, but later invited us to see her there. Another user proudly showed us his flat and explained his pictures, his TV and how he operated it. Service users were involved in cooking, but at the time of the site visit none of them cooked independently. However, with staff support, some of them contributed to everydays tasks in the home. Menus were displayed in picture format and allowed choice and proper nutrition. For users with weight issues the home arranged weight charts and monitored users weight to ensure their well being. The range of activities, participation of users, choices and respect for users preferences exceeded minimum standards. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home respected service users wishes, privacy and dignity when their healthcare was dealt with. Service users were protected with clear and safe healthcare and medication procedures and practices. Evidence: Various evidence was checked regarding personal and health care provided to the users of the service. Users files contained records of their likes and dislikes and preferences on how they wanted staff to support and help them. In the notes from the review of the Person Centred Care Planning meeting, areas addressed included: behaviour, health, holidays, leisure, dreams and fears. Another file contained evidenced refusal of a user to wear sling for a broken shoulder, but the staff at home knew how to support and monitor her to ensure that the healing process runs as expected. The home requested a blood test for a user whose bones were thinning. Personal care was also addressed in detail and agreed with users of the service. One file showed that a user needed help to choose matching socks, but was able to dress independently. The home arranged an occupational therapy assessment for a user prior to suggesting
Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: her to move to ground floor. All staff were trained and certificated for administration of rectal diazepam (a drug used for epilepsy) from nurses from the National Society for Epilepsy (NSE). The managers certificate was checked. Medication storage, records and procedures were checked for three case tracked users. All records were accurate. The storage room was improved as a light was installed in a cupboard in the room where the medication was stored. At the time of the site visit no users were prescribed any controlled drugs, but the facility for it existed and the book for recording was available. Users wishes after death were recorded in their files. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home valued highly the safety of service users and a number of procedures and policies were in place to ensure users protection. Evidence: There were no reported complaints or allegations that would require referrals to the POVA (Protection of Vulnerable Adults) register. The complaints procedure was produced in picture format and was displayed in the home, allowing anyone to raise a complaint if they wished to do so. Service users spoken to confirmed that they knew how to complain, but, as two of them stated, they did not have any complaints. The homes policies and procedures ensured protection of service users. Care Homes for Adults (18-65 years) Page 18 of 27 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users felt free and comfortable in a safe and well-maintained environment. However, a clear plan for re-development with a time scale was necessary to ensure that service users could all enjoy communal areas at the same time, as the current layout was too small for all of them to sit comfortably together. Evidence: Service users were observed returning home from the day centre. The way they entered the home and behaved in the home illustarted that they felt at home and had the feeling of possessing their home. The respect for their dignity and the fact that staff always asked for permission to go to their individual flats emphasised how users perceived their tenancy. The location of the premisses, not far from the main city centre, allowed easy access to shopping and community resources. The premisses were clean and safe. The manager explained the discussed plans for redevelopment of communal areas. The plans were to convert the current dining/living room into a lounge that would accommodate all users at the same time. The proposed kitchen would move into the current laundry room and the laundry room would become the kitchen. The initial time scale verbally suggested was July for the work to start. However, there
Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: were no evidence that the plans were accepted and the manager was asked to forward plans to the regulatory authority, thus informing us of the time scale for the necessary improvements in the environment for service users. The verbal plan included converting a bathroom upstairs into the walk-in shower, as the occupational therapist assessed the needs of the user who lived in the flat next door to the bathroom. Four flats were on the ground floor and 4 on the first floor. All service users spoken to confirmed that they were happy with the environment. Two of them that showed us their individual flats, with little kitchenettes and bathing facilities stated that the flats met their needs. Flexibility offered when flats were furnished included bringing in personal items if users wanted. The fire department inspected the premises recently and did not find any safety problems in their report. The laundry room was equipped to meet the needs of service users. The homes water system was checked agains Legionella. The staff recorded water temperatures and ensured good protection of service users. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team was skilled, experienced and able to meet the service users needs. Service users were protected by procedures that ensured proper vetting of new staff and training appropriate to their roles. Evidence: Staff were clear of their roles. This was observed doth during the handover and while they were observed helping users on their return home from the day centre. Staff spoken to were clear of the homes objectives and aims and they worked collectively as a team to help users achieve their individual aims. Staff were motivated and well trained. The record kept in the home that included basic details, records of supervisions, appraisals and training showed that the company and the management ensured that staff were well prepared to do their job. Main files were kept in the head office and our Provider Relationship Inspector reported that all necessary documents were there in staff files. Staff members were approachable and good listeners as they showed during the site visit. Service users spoken to stated that they felt well cared for, supported and respected by the staff. The majority of staff held NVQ qualifications, exceeding the standard that required 50 NVQ of trained staff. Staff team work and atmosphere were seen during the site visit and two users
Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: commented on staff qualities and knowledge that allowed them to meet the users needs. Recruitment details were kept in the head office, but basic reports held here, in the home showed that all necessary checks were carried out prior to starting wotk with service users. Staff spoken to commented that they felt supported and well guided to do their job. Training records, as well as supervison records showed that staff were up to date with these supportive measures. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensured that safe working practices were in place and service users benefited from clear safe working procedures. Evidence: The manager of the home was experienced and skilled and ensured that the home was run in a way to meet users needs. She achieved the RMA (Registered Managers Award) and attended relevant training. She became a qualified person to provide training on chiropody service, that service users would benefit from when more staff were trained and could safely perform this task. Service users views were sought and their voice listened to in the running the home. An example was at the feedback of this inspection, when a service user was present and confirmed the outcomes discussed. The organisation carried out quality assurance reviews each year and the home was just about to start another review through surveys for users, their relatives and other professionals involved in users care. Safe working practices were in place and ensured good standards of care through
Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: regular staff training and updated policies that included moving and handling, first aid, food hygiene and infection control measures and procedures. The water system was regularly checked to reduce risk of legionella and potential risks from hot water. Reportable incidents were regularly reported, two events that affected users were reported prior to this site visit and all accidents/incidents were recorded in users files allowing the measures for reducing risks to be put in place. Communication with users was improved by training both staff and users on appropriate communication methods, such as the use of Makaton, a sign language. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 23 23 The manager must inform the Commission about the dates of the proposed plan for redeveloping communal areas that would provide sufficint space for all service users to sit together at the same time. This would ensure that the time for work on redevelopment prevents service users sit together as required by Care Homes Regulations. 30/06/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!